低滴度O型全血比例对小儿创伤患者复苏后6小时、12小时和24小时生存率的影响。
The effect of the proportion of low-titer O whole blood for resuscitation in pediatric trauma patients on 6-, 12- and 24-hour survival.
作者信息
Petersen Ethan M, Fisher Andrew D, April Michael D, Yazer Mark H, Braverman Maxwell A, Borgman Matthew A, Schauer Steven G
机构信息
From the Department of Surgery (E.M.P., A.D.F.), University of New Mexico Hospital, Albuquerque, New Mexico; Department of Military and Emergency Medicine (M.D.A.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology (M.H.Y.), University of Pittsburgh, Pennsylvania; Department of Surgery (M.A. Braverman), St. Lukes University Health Network, Bethlehem, Pennsylvania; Department of Pediatrics (M.A. Borgman), UT Southwestern Medical Center, Dallas, Texas; Department of Anesthesiology (S.G.S.), Department of Emergency Medicine (S.G.S.), and Center for Combat and Battlefield (COMBAT) Research (S.G.S.), University of Colorado School of Medicine, Aurora, Colorado.
出版信息
J Trauma Acute Care Surg. 2025 Apr 1;98(4):587-592. doi: 10.1097/TA.0000000000004564. Epub 2025 Feb 3.
INTRODUCTION
Hemorrhage is a leading cause of death in pediatric patients. Accumulating data suggest that low-titer group O whole blood (LTOWB) improves clinical outcomes in the pediatric population. We examined what ratio of LTOWB to total blood product conferred a survival benefit in transfused pediatric trauma patients.
METHODS
We retrospectively examined a cohort of injured subjects younger than 18 years from the Trauma Quality Improvement Program database who received any quantity of LTOWB and no documented prehospital cardiac arrest. We created a variable representing the volume of transfused LTOWB divided by the total volume of all transfused blood products administered within the first 4 hours of admission, that is, the proportion of LTOWB transfused. We analyzed increasing proportions of transfused LTOWB to determine whether there was an inflection point conferring increased survival.
RESULTS
From 2020 to 2022, 1,122 subjects were included in the analysis. The median (interquartile range) age was 16 (14-17) years. Firearms were the most common mechanism at 47% followed by collisions at 44%. The median composite injury severity score was 25 (16-34). Survival was 91% at 6 hours, 89% at 12 hours, and 88% at 24 hours. We noted an inflection point with improved survival at an LTOWB proportion of ≥30% of total volume of blood products received. The odds of survival at 6, 12, and 24 hours for those receiving ≥30% LTOWB was 1.85 (1.02-3.38), 2.09 (1.20-3.36), and 1.80 (1.06-3.08), and 3.55 (1.66-7.58), 3.71 (1.89-7.27), and 2.69 (1.44-5.02) when excluding those who died within 1 hour, respectively.
CONCLUSION
Among LTOWB recipients, we found that a strategy of using LTOWB comprising at least 30% of the total transfusion volume within the first 4 hours was associated with improved survival at 6, 12, and 24 hours.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
引言
出血是儿科患者死亡的主要原因。越来越多的数据表明，低滴度O型全血（LTOWB）可改善儿科患者的临床结局。我们研究了LTOWB与全血制品的何种比例能使接受输血的儿科创伤患者获得生存益处。
方法
我们回顾性分析了创伤质量改进计划数据库中18岁以下的受伤受试者队列，这些受试者接受了任何数量的LTOWB且无院前心脏骤停的记录。我们创建了一个变量，代表输注的LTOWB体积除以入院后前4小时内输注的所有血液制品的总体积，即输注的LTOWB比例。我们分析了输注LTOWB比例的增加情况，以确定是否存在能提高生存率的拐点。
结果
2020年至2022年，1122名受试者纳入分析。中位（四分位间距）年龄为16（14 - 17）岁。最常见的致伤机制是火器伤，占47%，其次是碰撞伤，占44%。中位综合损伤严重程度评分为25（16 - 34）。6小时生存率为91%，12小时为89%，24小时为88%。我们注意到，当LTOWB占所接受血液制品总体积的比例≥30%时，生存率有所提高。接受≥30% LTOWB的患者在6、12和24小时的生存几率分别为1.85（1.02 - 3.38）、2.09（1.20 - 3.36）和1.80（1.06 - 3.08），排除1小时内死亡的患者后分别为3.55（1.66 - 7.58）、3.71（1.89 - 7.27）和2.69（1.44 - 5.02）。
结论
在接受LTOWB的患者中，我们发现，在最初4小时内使用占总输血量至少30%的LTOWB的策略与6、12和24小时生存率的提高相关。
证据水平
治疗/护理管理；三级。
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